Managing capacity and demand across the patient journey
Editor – Walley and colleagues recently highlighted the problem of reduced bed capacity which has an impact on coping with healthcare demand (Clin Med February 2010 pp 13–5).
I would like to comment on the long-term planning and that bed requirements are based on average demand and average length of stay, the author felt that this can create a problem as once there is random variation in demand and staff capacity, bed shortages will occur. I do not feel that we have a bed shortage in England. However, the discharge process is patchy and lengthy and there is a lack of coordination between hospital staff or secondary care and primary care as well as between NHS and social services.
I agree with the author that a ‘systems’ approach is the only solution where healthcare staff and social services, primary and secondary care work collaboratively. We may need a unified bed management team in every primary care trust which can allocate the patient after initial assessment to an acute hospital, a community hospital or to intermediate care. This requires training and commitments from all staff. The whole health and social care system should plan together how to meet the demand of the increasing elderly population. I should also emphasise the importance of multidisciplinary teams in each trust for effective discharge planning.
Footnotes
Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk
- © 2010 Royal College of Physicians
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